同型半胱氨酸水平对稳定型心绞痛患者介入治疗后血小板抑制率的影响

Analysis of platelet inhibition in stable angina pectoris patients complicated with hyperhomocystinemia after PCI

目的分析同型半胱氨酸水平对稳定型心绞痛患者介入治疗后血栓弹力图检测结果的影响。方法随机抽取北京安贞医院和阜外医院201 1年1月—2013年12月行冠脉介入治疗的患者450例,按照是否合并高同型半胱氨酸血症分为高同型半胱氨酸血症组(n=138)和正常同型半胱氨酸组(n=312),2组患者经常规术前检查、药物治疗和冠状动脉支架置入,入院后行常规检查及血栓弹力图检测。分析血栓弹力图各指标在2组间的差异。结果高同型半胱氨酸血症组男性占比、年龄、体质量、吸烟、高血压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、左室射血分数、高敏C反应蛋白显著高于正常同型半胱氨酸组(P<0.05),多因素回归分析显示,在控制上述组间有统计学差异的各因素之后,高同型半胱氨酸血症与二磷酸腺苷抑制率仍显著相关(r=0.889,P=0.000)。2组患者的血栓弹力图主要参数,包括R值、K值、α角和血栓形成的最大幅度(MA)差异均有统计学意义(P<0.05);2组花生四烯酸(AA)抑制率差异无统计学意义(P=0.072),而二磷酸腺苷(ADP)抑制率差异有显著统计学差异(P=0.000);且高同型半胱氨酸血症组氯吡格雷抵抗的发生率显著高于正常同型半胱氨酸组(26.8%vs.16.1%,P=0.022)。结论合并高同型半胱氨酸血症的稳定型心绞痛患者呈现高凝状态,且氯吡格雷抵抗发生率高,提示冠状动脉介入术后需要加强抗血小板治疗以减少心血管事件。

Objective To analysis the effect of homocysteine levels on the detection of the patients with stable angina pectoris after PCI .Methods Randomly selected Beijing Anzhen Hospital and Fuwai Hospital from 2011 January to 2013 De-cember 450 coronary interventional patients , according to whether with high homocysteine hyperlipidemia or not , patients were divided into high homocysteine hyperlipidemia group （ n =138） and normal cysteine groups （ n =312）, 2 groups of patients underwent the preoperative examination , drug therapy and coronary artery stent implantation , after admission , they underwent routine examination and thrombosis elastic graph detection .Analysis the index of the blood clots ’ differences between the 2 groups.Results High homocysteine group’s male patients ’ ratio, age, body weight, smoking, hypertension, low density lip-oprotein cholesterol , high density fat cholesterol ,left ventricular ejection fraction , hypersensitive C-reactive protein were sig-nificantly higher than that of normal homocysteine cysteine groups （ P ＆lt;0.05）.Multivariate regression analysis showed that , after control the various factors , statistically significant difference between and hyperhomocysteinemia and diphosphate adeno -sine inhibition rate were still existed （r =0.889, P =0.000）.Two groups of patients’ thromboelastography’s main parame -ters, including the R value, value K, alpha angle, and thrombosis of the maximum amplitude （MA） showed significant differ-ences （ P ＆lt;0.05）; arachidonic acid （AA ） inhibition rate’s difference was not statistically significant （ P =0.072） and adenosine diphosphate（ ADP） inhibition rate in the two groups had significant statistical differences （ P =0.000）;and high＆amp;nbsp;homocysteine clopidogrel resistance was significantly higher than that of the normal homocysteine cysteine groups （26 a.8%vs. 16.1%, P =0.022）.Conclusion Patients with stable angina pectoris with high homocysteine showed a high level of coagu -lation, and the incidence of clopidogrel resistance was high , suggesting that the need to strengthen anti platelet therapy after coronary intervention to reduce cardiovascular events .